张远波 翟海昕 邓海波

[摘要] 目的 总结15例心脏术后发生急性肢体缺血患者的护理经验。 方法 回顾北京协和医院心外科2011年5月～2018年2月共15例发生急性肢体缺血的患者护理资料，通过观察主观指标和客观指标，总结了从肢体灌注、抗凝治疗、康复和出院指导方面实施护理措施的经验和效果，提出不同于其他科室的护理重点。 结果 15例心脏术后早期发生花斑、淤紫和发绀但未进行性加重的10例，术后进行性加重，出现溃疡/坏疽5例，其中累及上肢3例，左/右足及下肢2例。经过医护人员的精心管理，至患者出院时，全部的15例患者中有10例恢复良好，至出院时仍就出现於紫及溃疡/坏疽5例，其中2例患者要求出院。 结论 通过对15例发生急性肢体缺血的患者护理经验的总结，给临床护理提供借鉴，促进患者的康复。

[关键词] 急性肢体缺血;低灌注;抗凝治疗;康复指导

[中图分类号] R654.4          [文献标识码] A          [文章编号] 1673-7210（2019）02（a）-0177-05

[Abstract] Objective To summarize the nursing experience of 15 patients with acute limb ischemia after cardiac surgery. Methods The nursing materials of 15 patients with acute limb ischemia from May 2011 to February 2018 in the Department of Cardiac Surgery of Peking Union Medical College Hospital were reviewed， by observing subjective and objective indicators， the experience and effect of nursing measures in limb perfusion， anticoagulant therapy， rehabilitation and discharge guidance were summarized， and the nursing emphases different from other departments were put forward. Results There were 15 cases of early postoperative ecchymosis， bruising， and cyanosis in 10 cases without progressive exacerbation， postoperative progressive exacerbation. There were 5 cases of ulcer/gangrene， including 3 cases of upper limb involvement， 2 cases of left/right foot and lower limb involvement. After careful management by the medical staffs， 10 of the 15 patients recovered well by the time they were discharged， by the time of discharge， there were still 5 cases of purpura and ulcer/gangrene， 2 of which required discharge. Conclusion By summarizing the nursing experience of 15 patients with acute limb ischemia， it can provide reference for clinical nursing and promote the recovery of patients.

[Key words] Acute limb ischemia; Low perfusion; Anticoagulant therapy; Rehabilitation guidance

急性肢體缺血（acute limb ischemia，ALI）是指对肢体存活力造成了潜在威胁的肢体灌注突然减少，表现为缺血性静息痛、缺血性溃疡和/或坏疽[1]。ALI可由急性栓塞、原位动脉血栓形成及直接的动脉损伤（外伤及医源性损伤）等所致。而心脏病患者术后发生急性肢体缺血的危险因素包括心房颤动导致的心房血栓形成、心肌梗死或左室功能不全后发生的左心室血栓形成，以及人工心脏瓣膜和发生感染的心脏瓣膜的碎片等形成的动脉栓子。急性肢体缺血的医院并发症发病率、死亡率以及肢体丢失率仍然很高[2]。……